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General NPI Number Information
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NPI Number | 1710605910
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Entity Type | Individual
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Provider Name | NICOLE RENAE REED
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 421 DORIS AVE
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City | JOLIET
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State | IL
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Zip | 60433-2569
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Country | US
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Telephone | 815-727-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 BELLAGIO CIR
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City | TINLEY PARK
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State | IL
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Zip | 60477-4099
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Country | US
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Telephone | 708-465-9402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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